Provider Demographics
NPI:1700367166
Name:LINCOLN
Entity Type:Organization
Organization Name:LINCOLN
Other - Org Name:HOPE CC CARMEN DRAGON ELEMENTARY
Other - Org Type:Other Name
Authorized Official - Title/Position:QA SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:CATALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MONROY-ABURTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-273-4700
Mailing Address - Street 1:1266 14TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-2205
Mailing Address - Country:US
Mailing Address - Phone:510-273-4700
Mailing Address - Fax:510-530-8083
Practice Address - Street 1:4721 VISTA GRANDE DR
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-8619
Practice Address - Country:US
Practice Address - Phone:925-779-7475
Practice Address - Fax:925-779-7476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health